Relapse after initial treatment will occur in approximately 10 to 15 percent of patients with early-stage disease and up to 40 percent of patients with advanced-stage disease at diagnosis [1-3]. Following the completion of therapy and restaging after the documentation of complete response, patients are seen at periodic intervals to assess a possible relapse. When planning the post-treatment surveillance strategy, care should be taken to limit the number of computed tomography (CT) scans, particularly in younger individuals, given concerns about radiation exposure and the risk for second malignancies [4-6]. There is no role for routine positron emissions tomography (PET) or PET/CT imaging in the longitudinal follow-up of asymptomatic patients after response assessment [7]. (See "Radiation-related risks of imaging".)

The majority (approximately 70 percent) of relapses occur within the first two years of diagnosis, and the risk of relapse declines thereafter. As an example, in one study of 1402 patients with HL followed for a median of 8.4 years, the risk of relapse within five years of diagnosis was 18 percent [8]. The risk of relapse within the subsequent five years declined for patients who were relapse free at one year (10 percent), two years (5.6 percent), three years (3.5 percent), and five years (2.5 percent). After three years, the prognosis of patients with advanced-stage disease is comparable to that of early-stage disease.

Although the risk of relapse declines with time, there is no time point after which relapses no longer occur. A retrospective study of nearly 7000 patients observed no plateau for late relapses of HL, and reported 2.5, 4.3, and 6.9 percent cumulative incidence of relapse at 10, 15, and 20 years, respectively [9].

To continue reading this article, you must log in with your personal, hospital,
or group practice subscription. For more information on subscription options, click below on
the option that best describes you: